title: Accuracy of diagnostic biopsy for cutaneous melanoma: implications for surgical oncologists.
abstract: OBJECTIVE
  While excisional biopsy is recommended to diagnose cutaneous melanoma, various biopsy techniques are used in practice. We undertook this study to identify how frequently final tumor stage and treatment recommendations changed from diagnostic biopsy to final histopathology after wide local excision (WLE).
  
  
  METHODS
  We compared the histopathology of the dermatopathologist-reviewed diagnostic biopsy and final WLE in 332 cutaneous melanoma patients.
  
  
  RESULTS
  Tumor sites were extremity (51%), trunk (33%), and head/neck (16%). Initial biopsy types were excisional (56%), punch (21%), shave (18%), and incisional (5%). Most diagnostic biopsies were margin positive regardless of technique, and 36% of patients had residual melanoma on WLE. T-stage changed in 8% of patients, of whom 59% were diagnosed by punch biopsy, 15% by incisional biopsy, 15% by shave biopsy, and 11% by excisional biopsy (P < 0.0001). Treatment recommendations changed in 6%: 2% after excisional biopsy, 5% after shave biopsy, 18% after punch biopsy, and 18% after incisional biopsy (P < 0.0001).
  
  
  CONCLUSIONS
  Although most biopsy margins were positive, T-stage and treatment changed for only a minority of melanoma patients. Our data provide valuable information to inform patient discussion regarding the likelihood of a change in prognosis and the need for secondary procedures after WLE. These data support the superiority of dermatopathologist-reviewed excisional biopsy when feasible.
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Skokie Hospital, Skokie, IL, USA ; Rush University Medical Center, Chicago, IL, USA ; Rush Medical College, Chicago, IL, USA ; Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.
authors.forename: Tina J
authors.initials: TJ
authors.lastname: Hieken
authors.forename: Roberto
authors.initials: R
authors.lastname: Hernández-Irizarry
authors.forename: Julia M
authors.initials: JM
authors.lastname: Boll
authors.forename: Jamie E
authors.initials: JE
authors.lastname: Jones Coleman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012680:Sensitivity and Specificity; D012867:Skin / Q000473:pathology*; D012878:Skin Neoplasms / Q000473:pathology*; D055815:Young Adult; D000096142:Cutaneous Malignant Melanoma